[Congressional Record (Bound Edition), Volume 154 (2008), Part 1]
[Senate]
[Pages 504-510]
[From the U.S. Government Publishing Office, www.gpo.gov]




    INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007--Continued

  The PRESIDING OFFICER. The Senator from Alaska.
  Mrs. MURKOWSKI. Mr. President, I wished to echo the comments of my 
colleague and my chairman on the Indian Affairs Committee. 
Reauthorization of this Indian Health Care Improvement Act is something 
that is long overdue. When we sat down as the chairman and vice 
chairman of this committee to assess the priorities of the committee, 
it was absolutely clear the one thing we could do now to help make a 
difference in the lives of American Indians and Alaska Natives was to 
improve the health care system, the delivery, and the access.
  The last time this was updated, if you will, was 1992. Think about 
what has happened in health care and the technologies and the 
techniques since 1992. We owe it to our constituents across the 
country--not just in Alaska, where we have 225 tribes, but from 
California to Maine, from the Dakotas down to Florida--we owe it to all 
our constituents to finally see this reauthorization through. We do 
acknowledge there are some issues that are as yet unresolved, but it is 
not as if we have not had the time to resolve them. The time is now to 
make it happen.
  I, too, would urge the Senate to work together, as the chairman and I 
have, in a very cooperative, very bipartisan manner to figure out how 
we move this legislation through the Senate to the House so it is 
finally enacted into law.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.


                           Amendment No. 3900

  Mr. SANDERS. Mr. President, I ask unanimous consent that the pending

[[Page 505]]

amendment be set aside so I can send an amendment to the desk, and I 
ask for its immediate consideration.
  The PRESIDING OFFICER. Without objection, the clerk will report.
  The legislative clerk read as follows:

       The Senator from Vermont [Mr. Sanders], for himself, Mr. 
     Obama, Ms. Cantwell, Mr. Kerry, Ms. Snowe, Ms. Collins, Mr. 
     Sununu, Mr. Menendez, Mr. Leahy, Mrs. Clinton, and Mr. 
     Kennedy, proposes an amendment numbered 3900.

  Mr. SANDERS. Mr. President, I ask unanimous consent that the 
amendment be considered as read.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To provide for payments under subsections (a) through (e) of 
   section 2604 of the Low-Income Home Energy Assistance Act of 1981)

       At the end of title II, insert the following:

     SEC. 2__. LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM.

       (a) In General.--There are authorized to be appropriated, 
     and there are appropriated, out of any money in the Treasury 
     not otherwise appropriated--
       (1) $400,000,000 (to remain available until expended) for 
     making payments under subsections (a) through (d) of section 
     2604 of the Low-Income Home Energy Assistance Act of 1981 (42 
     U.S.C. 8623); and
       (2) $400,000,000 (to remain available until expended) for 
     making payments under section 2604(e) of the Low-Income Home 
     Energy Assistance Act of 1981 (42 U.S.C. 8623(e)), 
     notwithstanding the designation requirement of section 
     2602(e) of such Act (42 U.S.C. 8621(e)).
       (b) Designation.--Any amount provided under subsection (a) 
     is designated as an emergency requirement and necessary to 
     meet emergency needs pursuant to subsections (a) and (b) of 
     section 204 of S. Con. Res. 21 (110th Congress), the 
     concurrent resolution on the budget for fiscal year 2008.

  Mr. SANDERS. Mr. President, let me begin by saying this amendment is 
being cosponsored by Senators Snowe, Collins, Obama, Cantwell, Sununu, 
Menendez, Stabenow, Clinton, Leahy, and Kerry. This amendment, which 
would increase LIHEAP funding by $800 million, also has the support of 
the National Energy Assistance Directors Association, the National Fuel 
Funds Network, the American Gas Association, the National Association 
of State Energy Officials, and many other groups.
  This amendment is as simple and straightforward as it can be, and 
what it is about is that at a time when, as everybody knows, home 
heating prices are going through the roof, it is getting colder every 
day--it will be below zero in Vermont this week--this amendment would 
provide real relief to millions of senior citizens on fixed incomes, 
low-income families with children, and persons with disabilities.
  Specifically, this amendment would provide $800 million emergency 
funding for the Low-Income Home Energy Assistance Program, otherwise 
known as LIHEAP. Four hundred million dollars of this funding would be 
distributed under the regular LIHEAP formula and the other $400 million 
would be used under the contingency LIHEAP program.
  Last month, I introduced the Keeping Americans Warm Act to provide $1 
billion in emergency LIHEAP funding. I am pleased that this bill has 
garnered 26 cosponsors--19 Democrats, 6 Republicans, and 1 Independent.
  In addition, as you know, on December 3, 38 Senators cosigned a 
letter spearheaded by Senator Jack Reed and Susan Collins to the Labor-
HHS-Education Appropriations Subcommittee Chairman Harkin and Ranking 
Member Specter urging the appropriations committee to provide a total 
of $3.4 billion in LIHEAP funding.
  As you know, there is a lot of discussion right now in seeing that 
there be a substantial increase in LIHEAP funding in the economic 
stimulus bill that is being talked about, which I certainly support.
  I would also like to take this opportunity to commend Subcommittee 
Chairman Harkin, Ranking Member Specter, Appropriations Chairman Byrd, 
and Ranking Member Cochran for providing a total of $2.6 billion in 
funding for LIHEAP in the Omnibus appropriations bill. I understand how 
difficult it was to reach a deal on this bill. I appreciate everything 
Senator Byrd and others have done for LIHEAP to make sure people in our 
country do not go cold.
  Unfortunately, this $2.6 billion in funding for LIHEAP, while an 18-
percent increase from last year, is still 23 percent below what was 
provided for LIHEAP just 2 years ago. And that 23-percent reduction is 
not even adjusted for inflation. I am talking about nominal dollars.
  Two years ago, as I think every American fully understands, the price 
of heating oil was less than $2.50 a gallon. Today, it is over $3.36 a 
gallon. In central Vermont, we have seen prices as high as $3.73 a 
gallon for heating oil. This winter, consumers are projected to pay 
over $1,800 to heat their homes with heating oil--$1,800 just to stay 
warm this winter. This winter, it is projected that consumers will be 
paying over $1,600 to heat their homes with propane. Two years ago, 
they only paid $1,281.
  The skyrocketing prices are already stretching the household budgets 
of millions of families with children, senior citizens on fixed 
incomes, and persons with disabilities beyond the breaking point. I 
cannot tell you--I am sure the situation is not radically different in 
Pennsylvania--how many people are telling me that when they see these 
heating bills, they cannot believe it. They just do not know how they 
are going to stay warm this winter.
  Unfortunately, the spike in energy costs is completely eviscerating 
the purchasing power of this extremely important program in State after 
State. If Congress does not act soon to confront this problem head-on--
and this is a problem which is existing now and will get worse in late 
January and in February--I fear for the public health and safety of 
many of our most vulnerable citizens.
  The point is, we have to act. We have to act. I support any and all 
efforts to expand LIHEAP but, frankly, it will do less good if it is 
passed in March or in April than it will if it is passed in January and 
February. We need to get the money out to people now so they do not go 
cold.
  According to the National Energy Assistance Directors Association, 
due to insufficient funding, the average LIHEAP grant only pays for 18 
percent of the total cost of heating a home with heating oil this 
winter, 21 percent of residential propane costs, 41 percent of natural 
gas costs, and 43 percent of electricity costs this winter. What this 
means is that low-income families with kids, senior citizens on fixed 
incomes, and others will have to make up the remaining cost out of 
their own pockets. As you know, in this country we are looking at some 
very rocky economic times. More and more people are unemployed. Poverty 
is going up. Where are those people going to get these large sums of 
money to stay warm this winter?
  In addition, only 15 percent of eligible LIHEAP recipients currently 
receive assistance with home heating bills. Eighty-five percent of 
eligible low-income families with children, senior citizens on fixed 
incomes, and persons with disabilities do not receive any LIHEAP 
assistance whatsoever due to a lack of funding. There are many people 
all over this country who are eligible for this program who are unable 
to get the help they need. In my own State of Vermont, it has been 
reported that outrageously high home heating costs, oil costs, are 
pushing families into homelessness. In fact, it is not uncommon for 
families with two working parents to receive help from homeless 
shelters in the State of Vermont because they cannot afford anyplace 
else to live during the winter.
  This is a national energy emergency which is affecting States all 
over the country, certainly not just Vermont. On January 17, 1 day 
after the President released $450 million in emergency LIHEAP funding, 
the National Energy Assistance Directors Association testified in front 
of the Health, Education, Labor and Pensions Committee chaired by 
Senator Kennedy. I very much appreciate his holding that hearing in 
Boston focusing national attention on this crisis. Here is what the 
national energy directors reported. This is what they say:
  In Arkansas, the number of families receiving LIHEAP assistance is 
expected to be reduced by up to 20 percent from last year if they are 
not able

[[Page 506]]

to get more funding. Arkansas, 20 percent reduction.
  In Arizona, estimates are that they will have to cut the number of 
families receiving LIHEAP assistance by 10,000 families as compared to 
last year.
  In Delaware, the number of families receiving LIHEAP assistance will 
be reduced by up to 20 percent. In most instances, your average LIHEAP 
grant only pays for about 20 percent of the total cost of heating a 
home in Delaware.
  During the winter in Iowa, the regular LIHEAP grant has been cut by 7 
percent from last year. The average LIHEAP grant in Iowa is $300. Two 
years ago, the average grant was $450.
  The State of Kentucky can run out of LIHEAP funding as early as next 
February.
  In Maine, the average LIHEAP grant will only pay for about 2 to 3 
weeks of home heating costs in most homes in that State, and I can tell 
you that it stays cold for a lot longer than 2 or 3 weeks in Maine, in 
New England.
  In Massachusetts, the spike in energy costs means that the purchasing 
costs for LIHEAP has declined by 39 percent since 2006.
  The State of Minnesota can run out of LIHEAP funding as early as 
February.
  In New York, many households have already exhausted their entire 
LIHEAP funding.
  While Ohio has seen a 10-percent increase in the number of people 
applying for LIHEAP assistance, that State will have to cut back its 
regular LIHEAP grant by between 15 to 20 percent.
  Rhode Island, Texas, the State of Washington--on and on it goes. The 
bottom line is, home heating fuel costs are soaring, and LIHEAP does 
not have enough money to take care of the needs of people in State 
after State after State.
  In the richest country on the face of the Earth, no family, no child, 
no senior citizen should be forced to go cold this winter. I am afraid 
that unless we act, and act very quickly, that is exactly what will be 
happening.
  We hear a lot of talking about energy funding around here. Not every 
piece of legislation, in fact, is an emergency. This is an emergency. 
As we speak tonight, people all over this country do not have enough 
money to stay warm. That situation will only get worse. We have to act, 
and we have to act now.
  Let me again thank the many cosponsors of this legislation. It is 
certainly bipartisan. There are cold people in Republican States, 
Democratic States, Independent States. We have to act together, and we 
have to move as rapidly as we can.
  I am offering this amendment now on the Indian health bill. I will 
offer it at every opportunity I can. I look forward to working with the 
Members of the Senate to see that we do the right thing so that no 
American goes cold this winter.
  Ms. COLLINS. Mr. President, I wish to discuss funding for the Low 
Income Home Energy Assistance Program, commonly known as LIHEAP. LIHEAP 
is a Federal grant program that provides vital funding to help low-
income and elderly citizens meet their home energy needs.
  Due to record-high oil costs, the situation for our neediest citizens 
is especially dire this winter. That is why I have sponsored Senator 
Sanders' amendment to increase LIHEAP funding by $800 million.
  Nationwide, over the last 4 years, the number of households receiving 
LIHEAP assistance increased by 26 percent from 4.6 million to about 5.8 
million, but during this same period, Federal funding increased by only 
10 percent. The result is that the average grant declined from $349 to 
$305. In addition, since August 2007, crude oil prices quickly rose 
from around $60 a barrel to nearly $100 a barrel earlier this month, so 
a grant buys less fuel today than it would have just 4 months ago. 
According to Maine's Office of Energy Independence and Security, the 
average price of heating oil in our State is $3.30 per gallon, which is 
$1.09 higher than at this time last year.
  This large, rapid increase, combined with less LIHEAP funding 
available per family, imposes hardship on people who use home heating 
oil to heat their homes. Low-income families and senior citizens living 
on limited incomes in Maine and many other States face a crisis 
situation in staying warm this winter.
  The Sanders amendment would provide an additional $800 million as 
emergency funding for LIHEAP. The term ``emergency'' could not be more 
accurate. Our Nation is in a heating emergency this winter. Families 
are being forced to choose among paying for food, housing, prescription 
drugs, and heat. No family should be forced to suffer through a severe 
winter without adequate heat.
  I urge all my colleagues to support the Sanders proposal to provide 
vital home energy assistance for the most vulnerable of our citizens.
  Mr. SMITH. Mr. President, I rise today to speak in favor of 
reauthorizing the Indian Health Care Improvement Act, IHCIA, of which I 
am a cosponsor. Like many of my colleagues, I feel that passing this 
legislation is long overdue. Since its enactment in 1976, the IHCIA has 
provided the framework for carrying out our responsibility to provide 
Native Americans with adequate health care. As we know, the act has not 
been updated in more than 16 years, despite the growing need among 
Native Americans.
  We cannot allow the health of Native Americans to remain in jeopardy 
for yet another year. The reauthorization legislation is a major step 
in addressing the growing health disparities that Native Americans 
face. The act makes much needed changes to the way the Indian Health 
Service, IHS, delivers health care to Native Americans and is the 
product of significant consultation and cooperation with Tribes and 
health care providers.
  I would like to thank Chairman Dorgan and Vice Chair Murkowski for 
their leadership and for building on the momentum from the last 
Congress to reauthorize this act.
  The IHCIA was last reauthorized in 1992. Now 16 years later, another 
reauthorization is necessary to modernize Indian health care services 
and delivery and improve the health status of Native American people to 
the highest level possible.
  A September 2004 report released by the United States Commission on 
Civil Rights gives us a snapshot of the health crises Native Americans 
face. Native Americans are 770 percent more likely to die from 
alcoholism, 650 percent more likely to die from tuberculosis, 420 
percent more likely to die from diabetes, 52 percent more likely to die 
from pneumonia or influenza, and 60 percent more likely to die of 
suicide.
  Also, according to the CDC, American Indians and Alaska Natives, AI/
AN, also have the highest rate of suicide in the 15- to 24-year-old age 
group, and suicide is the second leading cause of death among Native 
American youth aged 10 to 24. The overall rate of suicide for American 
Indians and Alaska Natives is 20.2 per 100,000, or approximately double 
the rate for all other racial groups in the United States. Given these 
circumstances, the life expectancy for Native Americans is 71 years of 
age, nearly 5 years less than the rest of the U.S population.
  Many serious health issues affect our Native American population. 
Yet, today, funding levels meet only 60 percent of demand for services 
each year, which requires IHS, tribal health facilities and 
organizations, and urban Indian clinics to ration care, resulting in 
tragic denials of needed services. Reauthorization of the act will 
facilitate the modernization of the systems, such as prevention and 
behavioral health programs for the approximately 1.8 million Native 
Americans who rely upon the system. I sincerely hope that we can pass 
this legislation and send it to the President for his signature.
  Although this bill makes vast and necessary improvements upon current 
law, it is not perfect. In my home State of Oregon, as well as in many 
other States across the country, there is concern that the current bill 
creates inequities among the tribes related to the distribution of 
health care facilities funding. Senator Cantwell and I intend to offer 
an amendment that we

[[Page 507]]

are hopeful can resolve this issue because, ultimately we must ensure 
that all tribes are treated equitably.
  The current priority system outlined in S. 1200 seems to favor health 
facility construction in a few States and will harm Oregon's tribes as 
well as many others across the country. Since the original bill was 
drafted, the IHS and tribes have worked together to develop a new and 
more equitable construction priority system that more fairly allocates 
funds across Indian Country. This priority system includes the 
development of an area distribution methodology. This proposed 
methodology would provide for a portion of facility construction funds 
to be used to build health facilities that are not part of the current 
facilities priority system. Unfortunately, the language in S. 1200 does 
not explicitly account for this agreement made between the tribes and 
IHS through the National Steering Committee. Many tribes in Oregon and 
around the country have never received any construction funding and are 
concerned that the proposed language is outdated and will continue to 
cause their facilities to lose priority to the extent that it could be 
20 to 30 years until facility upgrades would occur.
  I offered an amendment during the May 2007 Senate Committee on Indian 
Affairs markup of S. 1200 that would have allowed for a portion of 
health facility construction funds to be distributed equitably among 
all of the IHS areas for local health facilities projects. I withdrew 
my amendment because Chairman Dorgan assured me that he would work with 
me to find a suitable compromise before the bill went to the floor. 
Since then, I have been working with my colleagues and national tribal 
organizations to develop compromise language. Yet, given all of this 
effort, some Senators are unwilling to compromise.
  Therefore, Senator Cantwell and I intend to offer our amendment which 
represents an appropriate middle ground for all tribes. I hope my 
colleagues will vote in favor of this amendment, and I look forward to 
continuing to work with them to explore other creative ways to identify 
approaches that address everyone's interest and ensures that all Native 
American Indians receive the health care they need and deserve.
  I am pleased to see that the bill contains my legislation, the 
American Indian Veteran Health Care Improvement Act. This legislation 
would encourage collaborations between the Department of Health and 
Human Services, HHS, and the Department of Veterans Affairs, VA, 
resulting in greater access to health care services for American Indian 
and Alaska Native, veterans of federally recognized tribes. This 
legislation also would ensure that these AI/AN veterans eligible for VA 
health care benefits delivered by IHS, an Indian tribe, or tribal 
organization will not be liable for any out of pocket expenses.
  American Indians and Alaska Natives have a long history of exemplary 
military service to the United States. They have volunteered to serve 
our country at a higher percentage in all of America's wars and 
conflicts than any other ethnic group on a per capita basis. As a 
result, they have a wide range of combat related health care needs. AI/
AN veterans may be eligible for health care from the Veterans Health 
Administration, VHA, or from IHS or both. Despite this dual 
eligibility, AI/AN veterans report the highest rate of unmet health 
care needs among veterans and exhibit high rates of disease risk 
factors.
  On February 25, 2003, HHS and the VA entered into a Memorandum of 
Understanding, MOU, to encourage cooperation and resource sharing 
between IHS and the VHA. The goal of the MOU is to use the strengths 
and expertise of both organizations to increase access, deliver quality 
health care services, and enhance the health status of AI/AN veterans. 
These collaborations are designed to improve communication between the 
agencies and tribal governments and to create opportunities to develop 
strategies for sharing information services and technology. The 
technology sharing includes the VA's electronic medical record system, 
bar code medication administration, and telemedicine. Also, the VA and 
IHS cosponsor continuing medical training for their health care staffs. 
The MOU encourages VA, tribal, and IHS programs to collaborate in 
numerous ways at the local level. These services may include referrals 
for specialty care at a VA facility, prescriptions offered by the VA, 
and testing not offered by IHS.
  At the local level, many partnerships are being formed among IHS, the 
VA, and tribal governments to identify local needs and develop local 
solutions. These may include outreach and enrollment for the VA's 
health system, initial screenings, and other health care services. The 
anticipated product of these collaborations is to ensure that quality 
health care is provided to all eligible AI/AN veterans.
  In my State, the Portland VA Medical Center and the Portland Area 
Office-IHS are working on a local MOU for the purpose of improving 
access to VA health care services for eligible AI/AN veterans. The Warm 
Springs Confederated Tribes have been instrumental in developing this 
agreement based on the needs of AI veterans on the Warm Springs 
Reservation. These veterans often are eligible for health benefits from 
both the VA and IHS, and it is their intended purpose to make care more 
seamless, thereby improving access and quality.
  In November 2001, President George W. Bush proclaimed National 
American Indian Heritage Month by celebrating the role of the 
indigenous peoples of North America in shaping our Nation's history and 
culture. He said, ``American Indian and Alaska Native cultures have 
made remarkable contributions to our national identity. Their unique 
spiritual, artistic, and literary contributions, together with their 
vibrant customs and celebrations, enliven and enrich our land.''
  An important part of the overall contribution of AI/AN peoples to our 
Nation is the part they play in protecting and preserving our freedoms. 
Their contributions to our Armed Forces have been made throughout our 
history. I am hopeful that the VA and IHS will continue to work 
together to deliver health care services to our Nation's AI/AN veterans 
that they so deserve. I look forward to hearing about more of these 
partnership projects, and to learn of their successes.
  As I mentioned earlier, Native Americans have some of the highest 
suicide rates in our Nation. That is why it is so critical that we 
increase physical and mental health services to this population and, 
ultimately, that we pass this bill. I am proud to have cosponsored the 
telemental health language in this bill. The bill would authorize a 
demonstration project to use telemental health services for suicide 
prevention and for the treatment of Indian youth in Indian communities. 
The Indian Health Service would carry out a 4-year demonstration 
program under which five tribes, tribal organizations or urban Indian 
organizations with telehealth capabilities could use telemental health 
services in youth suicide prevention and treatment.
  I also would like to speak to my support of the Urban Indian Health 
Program, UIHP. It constitutes only 1 percent of IHS's budget; however, 
34 UIH centers provide care for nearly 70 percent of the Native 
American population residing in cities. According to the 2000 Census, 
nearly 70 percent of Americans identifying themselves as having 
American Indian or Alaska Native heritage live in urban areas.
  In my home State of Oregon, the Native American Rehabilitation 
Association of the Northwest, NARA, an urban Indian health provider, 
has been in existence for over 37 years and provides education, 
physical and mental health services, and substance abuse prevention and 
treatment that is culturally appropriate to Native Americans and other 
vulnerable people. NARA is an Indian-owned and operated nonprofit urban 
Indian health clinic that annually serves over 4,000 people including 
257 tribes and bands, of which 25 percent are from Oregon. NARA's 
health clinic delivers health care services to tribal members from over 
half of the federally recognized tribes that reside in about 30 States. 
Notably, NARA is a grant recipient of the Garrett Lee

[[Page 508]]

Smith Memorial Act, which it uses to serve Oregon's tribes.
  The UIHP has been a fixture of the Indian Health Care Improvement Act 
since its initial passage in 1976, principally serving urban Indian 
communities in those cities where the Federal Government relocated 
Indians during the 1960s and 1970s. Notably, the Federal Government 
relocated thousands of tribal members to Portland at that time. 
Although the UIHP overwhelmingly serves citizens of federally 
recognized tribes, it has the authority to serve other Native 
Americans, largely those who have descended from the Federal 
relocatees. S. 1200 provides a modest expansion of authority for the 
UIHP to engage in a wider array of health related programs, consistent 
with the many changes that have occurred in health delivery in the 
United States since the IHCIA was last reauthorized 16 years ago.
  Proposals to eliminate or even limit the UIHP within the IHS would 
have far-reaching and devastating consequences. Urban Indian health 
clinics report that the elimination of Federal support would result in 
bankruptcies, lease defaults, elimination of services to tens of 
thousands of Indians who may not seek care elsewhere, an increase in 
the health care disparity for American Indians and Alaska Natives, and 
the near annihilation of a body of medical and cultural knowledge 
addressing the unique cultural and medical needs of the urban Indian 
population held almost exclusively by these programs. Notably, Urban 
Indian health clinics typically leverage IHS funding 2:1 from other 
sources.
  Urban Indian health clinics provide unique and nonduplicable 
assistance to urban Indians who face extraordinary barriers to 
accessing mainstream health care. Many Native Americans are reluctant 
to go to health care providers who are unfamiliar with and insensitive 
to Native cultures. Urban Indian programs not only enjoy the confidence 
of their clients but also play a vital role in educating other health 
care providers in the community to the unique needs and cultural 
conditions of the urban Indian population. Urban Indian health clinics 
also save costs and improve medical care by getting urban Indians to 
seek medical attention earlier; Provide care to the large population of 
uninsured urban Indians who otherwise might go without care; and reduce 
costs to other parts of the Indian Health Service system by reducing 
their patient load.
  More than 30 years ago, President Ford saw the great need and had the 
wisdom to sign into law the Indian Health Care Improvement Act. His 
signature was a promise made to American Indians that the Federal 
Government would work to improve their health status. That promise is 
one that we must not back away from. Reauthorizing this act is a 
reaffirmation of that commitment and proves that we understand there is 
work yet to be done to further improve Indian health.
  Again, I am thankful to Chairman Dorgan and Vice Chair Murkowski for 
their leadership and for building on the momentum from the last 
Congress to reauthorize the act. I hope that we can swiftly resolve any 
remaining issues and get this long-overdue bill signed into law.
  I would like to close my statement with a quote from Mourning Dove, 
the literary name of Christine Quintasket, a Salish tribal woman from 
the Pacific Northwest now recognized as the first Native American woman 
to publish a novel (1888-1936). ``Everything on the earth has a 
purpose, every disease an herb to cure it, and every person a mission . 
. . this is the Indian theory of existence.''
  There are indeed cures and treatments for the maladies that 
disproportionately afflict Native Americans: diabetes, alcoholism, and 
suicide. The purpose and the mission of this bill is to connect those 
cures with those who need it the most--those who have sought it the 
longest--and through chapters of our history, have a unique claim to 
those cures and treatment.
  Mr. COCHRAN. Mr. President, I am a cosponsor of the Indian Health 
Care Improvement Act, which provides updated objectives and policy for 
addressing the health needs of American Indians.
  By virtue of many treaties and agreements, the Federal Government has 
a trust responsibility--an obligation--to provide a variety of basic 
needs, including healthcare.
  The Indian Health Care Service estimates that it provides about 60 
percent of the health care that is needed in Indian Country: an amount 
that is less than half of what we spend on the health care needs of 
Federal prisoners. Tribes with the resources, try to make up the 
difference. In most cases, the result is an absence of health care.
  In my State, the Mississippi Band of Choctaw Indians has improved its 
health care and the overall health of its population over the last 30 
years. But the sad fact remains that health care on the reservation is 
inadequate.
  For the 9,600 members of the tribe, there are four doctors. The 
hospital has 14 beds. The approximately $8 million the tribe spent last 
year is simply not enough to cover the needs of the Choctaw's growing 
population.
  According to Health Care Financing Review--Summer 2004, Volume 24, 
Number 4--the national health care expenditure average cost per person 
per year was calculated at $5,440. Using the $5,440 estimate, the 
Mississippi Band of Choctaw Indians Health Care System would need over 
$48 million dollars to cover the tribe's health care costs.
  From fiscal year 2000 to fiscal year 2005, there was a 30.4 percent 
increase in the number of patients from the Mississippi Band of Choctaw 
Indians who accessed the health care system. During that same time 
period there was a 41.4 percent increase in the number of ambulatory 
visits.
  According to the CDC, 7 percent of Americans have diabetes. In 
comparison, 20.5 percent of Choctaws have diabetes, one of the highest 
percentages of any tribe in the country. From 2000 to 2005 there was a 
62.3 percent increase in the number of patients diagnosed with 
diabetes.
  My point in telling the Senate these examples is, with adequate 
health care, successful preventive care, appropriate facilities, and 
more health care professionals, lives would be longer and general 
health would improve.
  Statistics for other tribes are similar. Some include alarming 
incidences of suicide, high infant mortality rates, and practically 
nonexistent mental health care.
  This bill includes provisions that promote better communication 
between tribes and the Indian Health Care Service, in order to ensure 
effective administration of the programs meant to assist the well-being 
of the American Indian population.
  I urge my colleagues to vote for the Indian Health Care Improvement 
Act.
  (At the request of Mr. Reid, the following statement was ordered to 
be printed in the Record.)
 Mr. OBAMA. Mr. President, I commend Senator Dorgan and the 
Committee on Indian Affairs for their leadership on the long-overdue 
Indian Health Care Improvement Act, IHCIA, Amendments of 2007.
  The historical treatment of Native Americans is a tarnished mark on 
American history. Lawmakers must ensure that this Nation fulfills its 
treaty obligations to Native Americans and address the injustices that 
continue to be suffered by the first Americans. I am committed to 
making sure that Native Americans are treated with respect, dignity, 
and equality both now and in the future and to ensure that promises 
made by this great Nation are promises kept as well. As such, I believe 
it is this country's moral imperative to address the significant health 
disparities between Native Americans and the American population as a 
whole.
  Diabetes is perhaps the most striking example of such health 
disparities. American Indians have the highest rate of diabetes in the 
world. The American Diabetes Association reports that American Indians 
and Alaska Natives are more than twice as likely to be diagnosed with 
diabetes as non-Hispanic Whites, and the death rate from diabetes is 
three times higher among American Indians and Alaska Natives than the 
rate in the general U.S. population. Yet these statistical averages 
mask the fact that certain tribal populations are

[[Page 509]]

experiencing epidemic rates of diabetes. About half of adult Pima 
Indians, for example, have diabetes. Even worse, on average, Pima 
Indians are only 36 years old when they develop diabetes, which 
contrasts to an average age of 60 years for White diabetics.
  Unfortunately, diabetes is not the only health condition that 
disproportionately affects American Indians. Death rates from heart 
disease and stroke are respectively 20 and 14 percent greater among 
American Indians compared to the average U.S. population. We know the 
infant mortality rate is 150 percent higher for Indian infants than 
White infants. The rate of suicide for Indians is 2\1/2\ times greater 
than the national rate, and methamphetamine use has ravaged Indian 
reservations all across the country.
  Urban Indians are not exempt from these dire health challenges. In 
addition to facing higher than average rates of chronic disease and 
mental health and substance abuse disorders, urban Indians experience 
serious difficulties accessing needed health care services. Given that 
over half of the Native American population no longer reside on 
reservations, our efforts to improve Indian health and health care must 
include explicit focus on the urban Indian population.
  For these reasons, I am proud to be an original cosponsor of the 
Indian Health Care Improvement Act. Our tribal health care programs 
must be modernized and prepared to provide preventive and chronic 
disease health care services and to address other key issues such as 
access and quality of care concerns. And these activities must be 
supported while honoring the principle of tribal sovereignty.
  The bill before us would enact much needed advancements in the scope 
and delivery of health care services to Native Americans. In 
particular, it authorizes a host of new health services, makes crucial 
organizational improvements, and provides greater funding for 
facilities construction. Through scholarships, investments in 
recruitment activities, loan repayment programs, and grants to 
institutions of higher education, IHCIA also takes steps to help 
increase the number of Native Americans entering the health services 
field.
  I am especially pleased that the bill addresses well-documented 
health problems affecting urban Indian communities as well. This 
proposal provides grants and increased aid for diabetes prevention and 
treatment, community health programs, behavioral health training, 
school health education programs, and youth drug abuse programs in 
urban areas.
  I trust my colleagues will agree with me on the critical need to 
address health disparities facing the Native American community. I urge 
the Senate to act quickly to pass this bill.
 Mr. McCAIN. Mr. President, today the Senate is considering S. 
1200, the Indian Health Care Improvement Act, IHCIA, Amendments of 
2007. This bill would reauthorize the IHCIA, the statutory framework 
for the Indian health system, which covers just about every aspect of 
Native American health care.
  I would first like to acknowledge the hard work of Chairman Dorgan 
and my other colleagues on the Senate Indian Affairs Committee for 
their efforts to bring this important legislation to the floor. 
Reauthorization of the IHCIA is critical to the lives of more than 2 
million American Indians and Alaska Natives and is long overdue.
  The IHCIA expired in 2000, and Indian tribes and health organizations 
have been working diligently to see it reauthorized. Seven years ago, a 
steering committee of tribal leaders, with extensive consultation by 
the Indian Health Service, developed a broad consensus in Indian 
Country about what needs to be done to improve and update health 
services for Indian people. During the 109th Congress, we made 
significant progress towards passing a reauthorization bill. 
Unfortunately, the Senate was unable to complete work on that bill 
before adjourning last Congress.
  I believe now as I did when I served as chairman of the Senate Indian 
Affairs Committee during the last Congress that reauthorizing our 
Indian health care programs is a top priority for us, and I hope that 
the Senate will move a sound comprehensive bill through the legislative 
process as quickly as possible. However, there are some key and 
troubling differences between the bill pending before the Senate and 
the proposal I put forward at the end of the last Congress, S. 4122. In 
particular, the new version contains language that would essentially 
authorize the Indian Health Service to promote ``reproductive health 
and family planning'' services. As my colleagues know, I have had a 
longstanding policy against promoting abortion as an acceptable form of 
birth control, except in cases of rape and incest. I strongly believe 
that society and government have a legitimate interested in protecting 
life, born or unborn. Obviously, my thinking on this question applies 
to the unborn children of patients to the Indian Health Service. I 
cannot in good conscience support the promotion of abortions at 
Federally funded IHS facilities or any Federal facilities. I remain 
hopeful the bill will be modified to allow me to supports its swift 
passage.
  I am, however, supportive of the majority of this bill which builds 
upon the principles of Indian self-determination. Over the years, 
Indian health care delivery has greatly expanded and tribes are taking 
over more health care services on the local level. It is our 
responsibility to maintain support for these services and promote high 
standards of quality health care for IHS and its partner units. Among 
the items provided in this bill are provisions exploring options for 
long-term care, governing children and senior issues. It also would 
provide support for recruitment and retention purposes; access to 
health care, especially for Indian children and low-income Indians. 
Further, it would provide more flexibility in facility construction 
programs, consolidated behavioral health programs for more 
comprehensive care, and would establish a Commission to study and 
recommend the best means of providing Indian health care.
  We must remember that nearly 30 years ago, Congress first enacted the 
IHCIA to meet the fundamental trust obligation of the United States to 
ensure that comprehensive health care would be provided to American 
Indians and Alaska Natives. Yet the health status of Indian people 
remains much worse than that of other Americans. They have a shorter 
average lifespan, higher infant mortality rate, and a much higher rate 
of diabetes than the national average. American Indians and Alaska 
Natives are 650 percent more likely to die of tuberculosis, 770 percent 
more likely to die of alcoholism, and 60 percent more likely to die of 
suicide. The suicide mortality rate among Indian youth is three times 
that of the general population.
  I have seen the hard reality of these statistics in the families of 
Arizona tribes as well as tribes across the Nation. Methamphetamine 
addiction, diabetes, alcoholism, and heart disease are epidemics 
devastating the Indian people. Our trust obligation dictates we address 
these health crises on reservations, and I strongly support actions to 
that effect. However, as I stated before, using taxpayer money to 
promote abortion services is something I find highly objectionable and 
will vehemently oppose. I strongly urge my colleagues to support 
efforts to strike these unacceptable provisions and enable this bill, 
which is of critical importance to Indian country, to be 
approved.
  Mr. SANDERS. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. THUNE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. THUNE. Mr. President, is the pending business S. 1200, the Indian 
Health Care Improvement Act Amendments of 2007?
  The PRESIDING OFFICER. That is correct.
  Mr. THUNE. Mr. President, I wish to speak to that legislation. The 
Indian Health Care Improvement Act is before the Senate today and 
tomorrow and hopefully will be completed, and we

[[Page 510]]

will be able to vote on some amendments and finally get this 
legislation reauthorized because it is very long overdue and the need 
for its completion cannot be underestimated.
  I represent nine tribes in my State of South Dakota, and in any given 
year, depending on the year we are talking about, as many as five of 
those reservation counties in South Dakota will be in the top 10 
poorest counties in America. These are areas in my State that are 
struggling in so many different ways where many of the basic services 
that those of us who live off the reservations expect on a daily basis 
are just not available.
  One of the things that is desperately needed is access to health 
care, making sure there is quality health care available to people on 
the reservations.
  The Indian Health Care Improvement Act reauthorization has really 
been in the works since 1999-2000. I think the 106th Congress was the 
last time this issue was debated. We have been trying since that time 
to get this bill on the floor and get it reauthorized. It is a critical 
piece of legislation that is so important to the people whom I 
represent and to tribes all across this country and to Native American 
people.
  To give an example of what I am talking about, in South Dakota, 
between 2000 and 2005, Native American infants were more than twice as 
likely to die as White infants. Nationally, Native Americans are three 
times as likely to die from diabetes as compared to the rest of the 
population in the country.
  In South Dakota, a recent survey found that 13 percent of Native 
Americans suffered from diabetes. This is twice the rate of the general 
population in which only 6 percent are suffering from diabetes.
  An individual who is served by IHS is 6.5 times more likely to suffer 
an alcohol-related death than the general population. An individual 
served by an IHS facility is 50 percent more likely to commit suicide 
than the general population.
  I appreciate the time the Senate is taking to debate this bill and 
the serious health issues this bill hopes to address and correct. I 
especially thank the Indian Affairs Committee for working with me to 
help the Yankton Sioux Tribe of South Dakota keep the Wagner emergency 
room open. Our delegation from South Dakota has been working for some 
time in making sure that members of the Yankton Sioux Tribe have access 
to emergency room service 24 hours a day, which is critically 
important.
  The committee was very helpful in making sure that issue was 
addressed in this authorization. I thank them for that help and 
appreciate their work in working with us to that end.
  I also thank them for the work they have done to ensure that the 
Urban Indian Health Program remains a viable and helpful program for 
Native Americans who live off the reservation.
  I am also a cosponsor of an amendment that has been offered by 
Senator Vitter. I reiterate my support for extending the Hyde language 
of this bill in preventing Federal funds being spent on abortions, 
except in cases where the life of the mother is at stake or in case of 
incest or rape.
  I also reiterate my support for Senator Bingaman's amendment. I am a 
cosponsor of that amendment which will extend Medicare payment rates to 
all Medicare providers who accept IHS contracting agreements.
  This amendment hopefully will stretch IHS contracting dollars even 
further and help reduce, even if it is only in a small way, some of the 
shortfalls that currently exist.
  This legislation goes a long way in attempting to improve health care 
throughout Indian country. However, we have to remember there is still 
more, lots more, that we need to do, especially in the area of tribal 
justice and law enforcement in order to help improve the lives of 
individuals who live on and near Indian reservations throughout the 
country.
  Last year, I worked hard to improve tribal justice and law 
enforcement on Indian reservations, and I look forward to partnering 
with my colleagues in the Senate to continue that fight this year to 
make sure we have adequate law enforcement personnel, that we have an 
adequate number of prosecutors so that when crimes are committed, they 
can be prosecuted. But we have to address these very fundamental issues 
if we are going to improve the quality of life for people on the 
reservations.
  As I travel the reservations in South Dakota--and I was at the 
Rosebud Indian Reservation just this last week--what strikes me is, 
people on the reservations, just as those I represent who live off the 
reservations, want the same thing: They want a better life for their 
children, for their grandchildren, for future generations. They want to 
make sure they have security and there is adequate law enforcement and 
they do not have to live in fear when it comes to the issues of crime. 
They want to make sure their children have access to quality education 
and a responsibility that many of us take very seriously, ensuring and 
seeing to it that young people, children on the reservation, have an 
opportunity to learn at the very fastest rate possible, to go through 
elementary and secondary school and then on to higher education if they 
choose to.
  A number of the tribal colleges we support in many cases suffer, 
again, from a lack of funding. They also have to have basic health care 
services, which is what this bill attempts to address. Whether it is in 
the area of dental care, whether it is in the area of basic primary 
care, speciality care, the IHS facilities on the reservations suffer 
from being unable to recruit and retain health care providers. Whether 
it is physicians or dentists--and that is an issue we face as well--we 
need to make sure we have the right incentives in place to attract 
health care providers to serve in reservation areas.
  This bill, as it is currently structured, I believe, will help to 
address that very basic expectation that all people who live on 
reservations have, and that is, when they have a need, they will have 
access to quality health care to address those needs.
  This bill will be debated again tomorrow in the Senate, probably, I 
hope, voted on sometime tomorrow so that we can finally get this 
reauthorization bill through. It has been teed up for some time.
  I appreciate the work the chairman, Senator Dorgan from North Dakota, 
and Senator Murkowski from Alaska, the ranking Republican, have done to 
bring this bill to the floor and, as I said before, to work with us on 
issues important to South Dakota.
  I am also happy to cosponsor a couple of amendments that I hope can 
be adopted--the Vitter amendment and, as I said earlier, the Bingaman 
amendment, which will help make health care more available and take the 
dollars of the IHS and stretch them further when it comes to 
contracting services.
  I urge my colleagues in the Senate to vote for this bill. This should 
be a big bipartisan vote. If anybody cares seriously about improving 
the quality of life on reservations in this country and addressing what 
are deep economic needs, it starts with some of these very basic 
services. It starts with law enforcement security, it starts with 
education, and it starts with health care, and I think this bill takes 
us a long way in the direction of dealing with the health care issues 
that affect so many of our tribes in this country.
  I hope my colleagues in a very big bipartisan way will vote for this 
legislation, support it, and hopefully get it signed into law before 
this year is out.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER (Mr. Brown). The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CASEY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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